CO2 LASER
 This fact sheet was developed under the aegis of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as an addition to your initial consultation, to try to answer all the questions you can ask yourself if you plan to use a facial laser abrasion.
The purpose of this document is to provide you with all the necessary and essential elements of information to help you make your decision with full knowledge of the facts. Also you is it advisable to read with the greatest attention.
Already 3500 years before our era, written on papyrus extolled the benefits of abrasive pastes: the Egyptians used a solution of milk and honey with alabaster particles. This means that any time the man and the woman wanted to erase some superficial skin imperfections (wrinkles, scars, keratoses, age spots) by smoothing the surface of their skin and try to improve or maintain fresh and rejuvenating.
This smoothing is abrasion and abrasion techniques today are:
• Mechanics: the Dermabrasion
• Chemical: these are Peels
• Thermal: the Laser-abrasion
DEFINITION OBJECTIVES AND PRINCIPLES
The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation or Light Amplified by Stimulation Emission of Radiation.
Different lasers used for facial abrasion are essentially ultra-pulsed CO2 lasers and Erbium lasers.
 The laser works by destroying photovaporisation controlled by the surface layer of the skin, that is to say, the epidermis and superficial dermis can go up, depending on the purpose: it is a controlled burn.
The computerized control of the depth of the vaporization is effected by the number of passes of the laser beam, the energy emitted, its density. It depends on the size of the defect to be corrected, the area to be treated, the skin quality and purpose.
The surface layer is destroyed then restore by natural phenomena of healing from the islands of dermal-epidermal basement membrane and pilosebaceous annexes contained in the deep dermis is the reépidermisation or reepithelialization.
This implies a time of healing where the skin is fragile and requires careful attention.
This is the restoration of the skin surface that will create a smoother appearance: it is a smoothing which has the virtue of erasing, more or less, imperfections that is to be treated.
In addition, the dermal-epidermal healing will with some retraction of the skin skin true "tensor" skin effect, variable and more or less important depending on the case.
Fractionated lasers:
Another group via laser action is represented by fractionated lasers, CO2 or not, for which treatments are carried out in three or four sessions. They are less efficient than conventional CO2 or Erbium lasers but significantly more effective than other lighter processes. Unlike conventional laser abrasion, they do not destroy all of the epidermis of the skin in one session. They create separated from each other at which epidermis and dermis deeper or shallower areas are destroyed. As the surface is not affected by these wells in a session, the treatment must be repeated three or four times so that the entire surface of the skin is treated. This method of splitting treatment prevents crusting and complications of conventional lasers.
Fractionated CO2 lasers are less effective than conventional CO2 lasers but do not cause significant complications. They must be carried out under local anesthesia and their consequences are still responsible for social eviction of four to five days because of scabs. They are indicated in cases of marked skin aging but are reserved for clear skin. The neck and lower eyelids should be avoided.
Fractionated lasers other than CO2 are slightly less effective than fractional CO2 lasers. They must also be carried out under local anesthesia and suites are lighter with only transient redness and swelling for two to three days. They are shown in the case of aging skin beginner and intermediate. They can be used on all skin types, regardless of color and all locations, including eyelids and neck. This is the current standard treatment of aging skin is to be effective without being aggressive and risk of complications.
We can also use lighter technical are: lasers remodeling, rejuvenation or rejuvenation (flash lamp IPL ...), which have a very superficial effect, mainly epidermal, dermal or sometimes by fibroblast stimulation and small edema caused. They are much less aggressive than the ultra-pulsed CO2 lasers and Erbium lasers, but their effect is less. They do not cause any significant complication. The repetition of the sessions, no anesthesia, no social downtime may be of interest as a result with a bang, action on the skin, producing a cooling effect and action on very fine lines.
BEFORE THE OPERATION
The consultation aims to evaluate the application, specify the indication to inform the patient that can be treated and what does not and will explain all the facts relating to this type of intervention .
The preparation of the skin prior to surgery is important to optimize the result: skin cleansing creams with fruit acids or vitamin A acid, antibiotic coverage, anti-herpetic coverage, are sometimes prescribed by your surgeon during the two or three weeks before the act to prepare your skin so that it arrives at the time of the act in the best possible local conditions.
TYPE OF ANESTHESIA AND CONDITIONS OF HOSPITAL
These terms are to be discussed with your surgeon, the act may be done:
• Under local anesthesia, locoregional general or neuroleptic.
• With one or more hospital days or outpatient.
Type of anesthesia: The principle for anesthesia during a laser abrasion of the face, is seeking comfort, both for the patient and the practitioner. This goal is easier to achieve with a general anesthesia or analgesia:
• Classic General anesthesia, in which you sleep completely,
• Analgesia is a local anesthesia supplemented by tranquilizers administered intravenously (vigil anesthesia).
However, we may use local anesthesia
or truncal:
• The nerve blocks are very well suited for the eyelids and the middle part of the face (forehead, nose, lips and chin). These blocks are effective and easy to handle. They consist of the injection of anesthetic around a sensory nerve that innervates skin area: This area is numb and for the duration of the act.
• The local anesthesia: a local anesthetic is injected under the skin to numb the treatment area. The sides of the face (cheek, temporal region), inaccessible for nerve blocks, respond very well to this technique.
• The anesthetic cream EMLA such an interest on the thin skin especially if abrasion is superficial. Progress is expected for this type of numbing creams.
Terms of hospitalization: The intervention can be done "outpatient", that is to say with out the same day after a few hours of monitoring. If a hospital, usually quite short, is recommended, the entry is made the day before or the morning, with an exit at the next day or two.
INTERVENTION
After cleaning and disinfecting the skin and installation of barren fields, some precautions are in order and are part of safety that can guard against a possible accident orientation of the laser beam and damage.
• Protection of the patient's eyes (corneal protective lubricated), his hair, his eyelashes and eyebrows, his teeth (wet compresses)
• Eye protection of the operator and all persons in the room (glasses).
The laserabrasion is via a computerized collimated handpiece. The surgeon directs the laser beam on the treatment area, the laser spot, whose size and shape are chosen by the operator, vaporizes the skin surface: it is a photovaporisation, that is to say an abrasion heat.
Controlling the depth of the vaporization is computerized: it is accomplished by varying the energy emitted, the fluence, the density of the laser spot and the number of passes.
This depth depends on the size of the defect to be corrected, the area to be treated, the skin quality and purpose. She appreciates, as well as the dermal contraction, after each passage thereby possibly change the settings if the surgeon decides to additional passages.
End of the saw laserbrasion exposed dermis causing bleeding. The dermis must be covered and protected: • is a closed dressing, dry or greasy, to redo all
days due to the large seepage
• is an open dressing that consists of the application of Vaseline to repeat fats pluriquotidiennement.
AFTER THE INTERVENTION: THE SUITES AND THE RESULT
     Immediately after treatment, abrasion exposes the dermis that causes redness, swelling and oozing.
Local care, based fats or dressings will be made until complete healing, resulting in 10 to 15 days, which requires a social eviction. Although directed by your surgeon, the local care to avoid scabbing, that even if they are not desirable and may eventually form should not be torn to meet the underlying healing in progress and not run the risk any residual scar.
A suitable makeup and sunscreen are recommended from the 10th day to cover a variable intensity erythema (red or pink appearance of the skin treated for 1-2 months or more which is not a complication, but a series normal).
A (anti-pruritic anti-herpetic analgesic, anti-inflammatory, antibiotic,) general treatment is prescribed concurrently.
The skin can be uncomfortable, dry, sensitive, irritable, intolerant of conventional beauty products for several weeks. Rashes with redness and heat may occur for several months.
This period is sometimes difficult to follow, on a psychological level for the patient: your doctor is there to help and advise you on the occasion of following the act and which are necessary in order to conduct healing consultations.
THE RESULT
The goal of these treatments is to make an improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction.
INDICATIONS
Indications that the area: The most favorable area is the face.
Indications that the cause
• The resurfacing by laserabrasion essentially treats the skin from one area of the face or the entire face, marked by signs of aging including solar (superficial wrinkles, elastosis, spots). Eyelid regions, lip, face and chin are the most commonly affected.
It is a treatment of the skin surface which can, of course, be associated with processing techniques sagging skin associated with aging such as facelift, blepharoplasty. It may also be combined with other techniques such as injections of fillers or botulinum toxin.
In the treatment of the signs of aging, there are also laser remodeling, rejuvenation or rejuvenation (flash lamp IPL ..) They are much less aggressive than lasers lasers ultra-pulsed CO 2 or Erbium lasers. Their effect is however smaller, but significant risk of complication and without social restraint. They essentially epidermal very superficial action and are used without anesthesia.
Subject to repeated sessions, the result is positive: bang, action on the skin, producing a cooling effect, action on very fine lines.
• Other indications are secondary: include depressed scars such as acne scars. The laser-abrasion will partially smooth the skin surface irregularities and improve.
POSSIBLE COMPLICATIONS
Abrasion facial laser, although carried out mainly for aesthetic reasons, not least is a skin attack, epidermal and dermal, implying the risks associated with any medical surgery.
By choosing a qualified and competent practitioner trained in this kind of treatment, you limit these risks without removing them completely.
Fortunately, real complications are rare after a laser abrasion carried out in the rules. In practice, the vast majority of these treatments is happening without any problems and the patient (s) are fully satisfied (s) of their income.
However, despite their rarity, you should be aware of possible complications:
• Herpes: antiviral treatment will be prescribed before and in the days that followed,
• Microbial Infection
• Pushing acne
• Grains of milia (small white cysts)
• Hyperpigmentation (especially on dark skin), early and almost always temporary, it is often due to premature exposure to the sun.
• Hypopigmentation often ultimately occurs more rarely and later,
• Persistent Redness,
• Impaired wound healing and hypertrophic scars
are possible but rare. They show too deep destruction, scraping, a breach of the fragile réépidermisation the beginning of healing, infection or poorly treated late.
• Allergy: Products used for the disinfection of skin care and can also cause allergies, so it is important to consider any allergies that the patient has had during his life.
• Pain in the early days, diffuse sensation of warmth or burning at the treated area. A prescription painkillers will be made by the physician.
• Insufficient result, especially because of the size of the defect to be corrected: in these cases, your surgeon will inform you of the benefits of a new treatment after a period of one year minimum.
• Injury to a body by the laser beam: the protection of the patient (corneal and protective eye drops, wet compress in the mouth ...) and surgeon (glasses) are part of the protocol established by your surgeon.
In total, it should overestimate the risks, but just be aware that medical and surgical act even seemingly simple, still a small share of hazards. The use of a qualified practitioner ensures that it has the training and skills to avoid these complications, which effectively treat if necessary.
 These are the pieces of information that we wanted to bring you in addition to the consultation. We recommend that you keep this document, read it again after the consultation and reflect "a clear head." This reflection may raise new questions for which you wait for additional information. We are available to talk during the next consultation, or by phone, or even on the day of surgery when we meet in any way before anesthesia.
AESTHETIC PLASTIC
& RECONSTRUCTIVE SURGERY
© Docteur Garson MAJ 2013